Eylea yields greatest quality-of-life gain in CRVO treatment

PHILADELPHIA — Aflibercept yielded the greatest increase in patient quality of life in the treatment of central retinal vein occlusion, while bevacizumab was most cost-effective, a speaker told colleagues here.

At the Wills Eye Alumni Conference, Bryan K. Hong, MD, described quality-adjusted life-year (QALY) and cost-utility data for Eylea (aflibercept, Regeneron), Avastin (bevacizumab, Genentech) and Lucentis (ranibizumab, Genentech).

“All anti-VEGF agents, particularly aflibercept, confer positive QALYs and, therefore, increased quality of life,” Hong said. “By conventional standards, only aflibercept and bevacizumab are cost-effective. Bevacizumab confers considerably greater value than any other intravitreal injectable from a societal cost perspective, according to [return on investment].”

Hong and colleagues culled data from the GALILEO study (aflibercept 2 mg), COPERNICUS study (aflibercept 2 mg), Epstein and colleagues (bevacizumab 1.25 mg) and CRUISE study (ranibizumab 0.5 mg). Costs were extracted from 2014 Medicare data.

Standardized cost-utility is based on a patient’s perceptions of health-related quality of life, Hong said.

“In ophthalmology, we judge our patient value gain by quality-of-life gain rather than length of life because we don’t really increase the length of life with our ophthalmological treatments,” he said.

In QALY measurement, a score of 1 denotes 20/20 vision and a score of 0 denotes loss of vision, Hong said.

At 1 year, QALY gains were 0.103 and 0.099 for aflibercept, 0.068 for bevacizumab and 0.073 for ranibizumab.

Cost-utility, or expenditure per QALY gain, was $114,102 for ranibizumab, $13,406 for bevacizumab, and $65,799 and $63,654 for aflibercept, Hong said. A cost-utility under $100,000 was considered cost-effective.

“At the end of the patient’s life, the only agent that breaks even is bevacizumab,” Hong said. – by Matt Hasson

Disclosure: Hong reports no relevant financial disclosures.